EP0449825B1 - Improved emulsions of highly fluorinated organic compounds - Google Patents

Improved emulsions of highly fluorinated organic compounds Download PDF

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Publication number
EP0449825B1
EP0449825B1 EP89905857A EP89905857A EP0449825B1 EP 0449825 B1 EP0449825 B1 EP 0449825B1 EP 89905857 A EP89905857 A EP 89905857A EP 89905857 A EP89905857 A EP 89905857A EP 0449825 B1 EP0449825 B1 EP 0449825B1
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Prior art keywords
emulsion
fluorinated organic
highly fluorinated
volume
emulsions
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EP89905857A
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German (de)
English (en)
French (fr)
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EP0449825A1 (en
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Robert J. Kaufman
Thomas J. Richard
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Hemagen PFC LP
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Hemagen PFC LP
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • A61K9/0026—Blood substitute; Oxygen transporting formulations; Plasma extender
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/02—Halogenated hydrocarbons
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T436/00—Chemistry: analytical and immunological testing
    • Y10T436/24—Nuclear magnetic resonance, electron spin resonance or other spin effects or mass spectrometry

Definitions

  • This invention relates to improved emulsions of highly fluorinated organic compounds and to processes of making and using them. More particularly, this invention relates to fluorocarbon-containing emulsions having acceptable particle size distributions both after sterilization and in the presence of serum, being safe at high doses and in total exchanges and having good shelf stability at room temperature.
  • These emulsions comprise a highly fluorinated organic compound, an oil, that is not substantially surface active and not significantly soluble in water and a surfactant.
  • the emulsions are characterized by a well defined relationship in the relative amounts of these three components.
  • Such emulsions are especially useful in compositions for use as oxygen transport agents, "artificial bloods", or red blood cell substitutes, in the treatment of heart attack, stroke, and other vascular obstructions, as adjuvants to coronary balloon angioplasty and cancer radiation treatment and chemotherapy and as contrast agents for biological imaging.
  • PFC perfluorocarbon compounds
  • Neat fluorocarbon liquids cannot be injected into the blood stream, because their hydrophobic character makes them immiscible in the blood. As a result, they may cause vascular obstruction and death when transported into small blood vessels. Accordingly, for medical uses that require intravascular injection, such highly fluorinated organic molecules must be dispersed as physiologically acceptable, aqueous emulsions. See, e.g., L. C. Clark, Jr. et al., "Emulsions of Perfluorinated Solvents for Intravascular Gas Transport", Fed. Proc. , 34(6), pp. 1468-77 (1975); K.
  • Particle Size Distribution Post Sterilization Less Than 400 nm
  • PSD critical parameter for stability and safety
  • Extensive prior art literature demonstrates that a PSD >400 nm results in excessive toxicity because large particles clog microcirculatory vasculature and results ultimately in ischemia. The particle size will also impact the rate of clearance from the circulatory system and emulsions which are not maintained in the circulatory system will not be efficacious as blood substitutes. Because terminal heat sterilization of these emulsions is necessary to eliminate the possibility of sepsis before use, emulsions which exhibit a PSD >400 nm (post sterilization) are, thus, not acceptable.
  • An acceptable emulsion should have an LD50 in rats of at least 16 ml/kg of the perfluorocarbon component -- the active ingredient of the emulsion.
  • Total exchange transfusions represent the most stringent test of emulsion safety and efficacy.
  • the animal's hematocrit is reduced to 3% or less, a level which would be fatal without intervention.
  • the candidate emulsion is isovolumically infused.
  • the animal's physiologic functions, survival, general appearance and health, and intravasculature persistence are then monitored. Emulsions which lead to a high level of survival are believed to have good safety and efficacy.
  • An acceptable emulsion should have at least a 70% survival rate in total exchanges in rats.
  • a key criteria for the commercial utility of an emulsion is its shelf stability. Emulsions which cannot be stored for several months at either 4°C, and more preferably 25°C, will not be useful in the field. Their shelf life will be too short with respect to the time lag between manufacturing and quarantine, shipping, and usage.
  • fluorocarbon-containing emulsions that are to be used as "artificial bloods” or “red blood cell substitutes” must deliver sufficient oxygen to the tissues of the body.
  • hemoglobin a highly specialized protein that on-loads oxygen in the lungs and off-loads oxygen in the tissues of the body.
  • atmospheric oxygen which has an oxygen partial pressure (p02) of approximately 150 mm Hg
  • p02 oxygen partial pressure
  • the arterial blood p02 is about 100 mm Hg (because of the water vapor saturating the gas in the pulmonary alveoli, the bronchial circulation and other sources of arterio-venous shunting through the lungs).
  • p02 oxygen partial pressure
  • this oxygen-carrying blood moves into the capillaries where it off-loads its oxygen to the tissues, it comes into dynamic oxygen equilibrium with the oxygen present in the perivascular interstitial fluid, which on average has a p02 of 40 mm Hg.
  • This difference in p02 level between the arterial and the venous side of the circulation permits delivery to the tissues of their normal requirement of about 5 ml of oxygen per 100 ml of whole blood (5 volume percent).
  • a fluorocompound-containing emulsion For use as an "artificial blood” or red blood cell substitute, a fluorocompound-containing emulsion should deliver at least as much oxygen as whole blood -- 5% by volume. At the 100% 02 breathing mixture used for up to 12 hours in critical care situations, such an emulsion should, thus, contain at least about 20% by volume of the fluorocompound. E.g.
  • emulsion should contain from about 25% to about 60% by volume of the fluorocarbon, and most preferably from 30% to 55% by volume.
  • most perfluorocarbon-containing compounds have similar Bunsen oxygen solubility coefficients. These range between about 0.32 to 0.35, i.e., the solubility of O2 in them is between about 32 to 35% (by volume).
  • Fluosol DA 20% the only fluorocarbon emulsion to reach clinical testing as an "artificial blood”. It is an about 10% (by volume) emulsion of two fluorocarbons -- perfluorodecalin and perfluorotripropylamine -- in a mixture of two surfactants -- egg yolk phospholipid and Pluronic (R) F-68. It is not stable in the liquid state and must be stored frozen (Yokoyama et al., supra ).
  • this emulsion contains only about 10% fluorocarbon by volume, it is much less therapeutically effective as an "artificial blood" than desired because of its low oxygen delivery capacity -- about 2.4% O2 at 100% inspired oxygen (see, e.g., "Fluosol-DA As A Red Cell Substitute In Acute Anemia", N.E. Jour. Med , 314, pp. 1653-66 (1986)). This is substantially less than the 5 volume % oxygen which must be delivered to sustain healthy physiologic function.
  • Shaw-Clark European patent application 231,091 One attempt to remedy the problems of these prior art fluorocarbon-containing emulsions is described in Shaw-Clark European patent application 231,091.
  • the emulsions of that application are characterized by high fluorocarbon contents and good stability at room temperature and after sterilization. They comprise an oil that is not substantially surface active and not significantly soluble in water, a surfactant and a highly fluorinated organic compound.
  • Shaw-Clark emulsions include some that do not satisfy all of the other requirements described above for emulsions preferred for use as "artificial bloods", oxygen transport agents, or contrast agents for biological imaging.
  • Jeppsson also refers to oil, surfactant and fluorocarbon-containing emulsions. See, e.g., Jeppsson, supra , and European patent applications 220,152 and 220,153. Jeppsson does not suggest that its emulsions permit the preferred higher concentrations of perfluorocarbons needed for "artificial bloods", oxygen transport agents or contrast agents for biological imaging. Nor does Jeppsson suggest that its emulsions satisfy the other requirements of preferred emulsions for use in these applications. In fact, the Jeppsson emulsions include many that do not satisfy all of these other requirements of the preferred emulsions described above.
  • This invention solves the problems referred to above. It provides for the first time emulsions of highly fluorinated organic compounds that satisfy all of the requirements of the preferred emulsions described above.
  • the emulsions of this invention are characterized by (1) a particle size distribution after sterilization of less than 400 nm, and preferably less than 300 nm; (2) a serum stability characterized by a particle size distribution of less than 400 nm, and preferably less than 300 nm, after five days in serum or ionic solutions; (3) an LD50 in rats of at least 16 ml/kg of the fluorocarbon component of the emulsion; (4) an at least 70% survival in total exchange in rats and (5) a shelf stability of at least several months at 4°C, and preferably at 25°C.
  • the improved emulsions of this invention comprise at least one highly fluorinated organic compound; an oil that is not substantially surface active and not significantly soluble in water; and a surfactant. More importantly, the emulsions of this invention are characterized by specific and defined relationships in the relative amounts of those three components.
  • the fluorocarbon component is present in the emulsion in an amount between 20% and 60% by volume.
  • the amounts of the surfactant and the oil are dependent on the volume percent of fluorocarbon and are defined by the volume depicted in Figure 1 and by the surfaces that define that volume.
  • This invention also includes the use of the emulsions for the preparation of a composition for oxygen transport, "artificial bloods” or red blood cell substitutes, and contrast agents for biological imaging, and in other medical compositions and applications known in the art.
  • Figure 1 is a three dimensional diagram --w/w % oil/fluorocarbon, w/w % surfactant/fluorocarbon, and vol % fluorocarbon-containing compound -- of the improved emulsions of this invention.
  • the volume depicted in Figure 1 and the surfaces defining it describe the improved emulsions of this invention.
  • the filled-in circles in Figure 1 represent emulsions of this invention that satisfy all of the requirements of the preferred emulsions described above.
  • the open circles represent emulsions that fail in one or more of those requirements.
  • the emulsions of this invention comprise at least one highly fluorinated organic compound; an oil that is not substantially surface active and not significantly soluble in water; and a surfactant.
  • the emulsions of this invention are stable at room temperature for long periods of time -- at least several months. They are stable to agitation and to mixing with various physiological additives, including, but not limited to, saline, Tyrode solution, lactated Ringer's solution, serum and serum products. They exhibit substantially no phase separation and substantially no change in particle size or droplet distribution during storage. Moreover, they permit the use of highly fluorinated organic compounds that exhibit acceptably rapid excretion times from the liver and other body tissues. And they permit the use of high concentrations of fluorocarbons, thereby producing the high oxygen delivery capacity emulsions required for use as therapeutically effective blood substitutes, oxygen transport agents and contrast agents for biological imaging. Because of their stability, they retain the above-mentioned properties even after sterilization in a conventional laboratory autoclave at 121°C for fifteen minutes.
  • highly fluorinated organic compounds that are useful in the emulsions and compositions of this invention are those previously said to be useful as oxygen transport agents, "artificial bloods" or red cell substitutes, and contrast agents for biological imaging.
  • these include perfluorocarbons, e.g., perfluorodecalin, perfluoroindane, perfluorotrimethylbicyclo[3.3.1]-nonane, perfluoromethyladamantane, perfluorodimethyladamantane, and perfluoro-2,2,4,4-tetramethylpentane; 9-12 C perfluoroamines, e.g., perfluorotripropylamine, perfluorotributylamine, perfluoro-1-azatricyclic amines; bromo- or iodo- substituted fluorocarbons; and F-4-methyloctahydroquinolizidine and perfluoroethers.
  • perfluorocarbons e.g.
  • the emulsions of this invention contain one or more of a perfluorocarbon and more preferably a perfluorocarbon selected from the group consisting of perfluorodecalin, perfluoromethyladamantane, perfluorodimethyladamantane, perfluorooctylbromide, perfluoro-4-methyloctahydroquinolizidine, perfluoro-N-methyldecahydroquinoline, F-methyl-l-oxa-decalin, perfluoro-bicyclo[5.3.0]decane, perfluorooctahydroquinolizidine, perfluoro-5,6-dihydro-5-decene, and perfluoro-4,5-dihydro-4-octene.
  • a perfluorocarbon selected from the group consisting of perfluorodecalin, perfluoromethyladamantane, perfluorodimethyladamantane, perfluorooctyl
  • the perfluorocarbon is perfluorodecalin or perfluorooctylbromide.
  • perfluorooctylbromide is the preferred highly fluorinated organic compound according to this invention.
  • the highly fluorinated organic compounds may comprise from 20% to 60% (by volume) of the highly fluorinated organic compound. More preferably, the emulsions of this invention comprise from 30% to 55% (by volume) fluorocarbon. Most preferably, the emulsions contain 40% by volume.
  • liquid fatty oils such as monoesters of a fatty acid and a monohydroxy alcohol, long chain ethers, diglycerides, silicone oils and nitriles.
  • oils include, for example, palmitoyl oleate, octyl nitrile, dodecyl nitrile, soybean oil, safflower oil, hexadecane, diglycerides having a C12-C18 carbon chain, and mineral oil.
  • these oils may be used singly or in various combinations in the emulsions and processes of this inventon.
  • the oil or combination of oils must, of course, be physiologically acceptable.
  • physiologically acceptable liquid fatty oils such as soybean and safflower oils.
  • surfactants useful in the emulsions of this invention are any of the known anionic, cationic, nonionic and zwitterionic surfactants. These include, for example, anionic surfactants such as alkyl or aryl sulfates, sulfonates, carboxylates or phosphates, cationic surfactants such as mono-, di-, tri-, and tetraalkyl or aryl ammonium salts, nonionic surfactants, such as alkyl or aryl compounds, whose hydrophilic moiety consists of polyoxyethylene chains, sugar molecules, polyalcohol derivatives or other hydrophilic groups that may be combinations of the above anionic or cationic groups, and whose hydrophobic moiety consists of any other polymer, such as polyisobutylene or polypropylene oxides.
  • anionic surfactants such as alkyl or aryl sulfates, sulfonates, carboxylates or phosphates
  • surfactants may, of course, be used in the emulsions of this invention.
  • mixtures of compounds, one or more of which are not surfactants, but which compounds when combined act as surfactants may also be usefully employed as the surfactant component of the emulsions of this invention.
  • the surfactant, or combinations of them must be physiologically acceptable.
  • the surfactants used in the emulsions of this invention are one or more of the following: egg and soybean phosphatides, lecithin, and any of the series of BASF Wyandotte formulations of polyoxyethylene oxides sold under the trade name "Pluronic", especially "Pluronic F-68".
  • Pluronic polyoxyethylene oxides sold under the trade name "Pluronic”
  • Pluronic F-68 polyoxyethylene oxides
  • many other polyethylene oxide based surfactants can be employed, but they are not typically as accessible through common channels of commerce.
  • the emulsions of this invention contain water and may also contain, or be mixed with, other components conventionally used in "artificial bloods" or red blood cell substitutes, oxygen transport agents or contrast agents for biological imaging.
  • these include isotonic agents, osmotic pressure controlling agents, serum extending agents and antioxidants.
  • glycerol as a tonicity adjusting agent during the preparation of these emulsions to obtain solutions of physiologically acceptable osmolarities. The proper amounts to obtain isotonicity with respect to whole blood will be obvious to those skilled in the art.
  • these emulsions may be mixed with 0.9% saline, lactated Ringer's solution, serum and serum products with no adverse affect on emulsion particle size and stability.
  • Other adjuvants can also be used in the emulsions of this invention. Among them are oncotic agents such as dextran, HES, and antioxidants.
  • the emulsions of this invention are characterized by a well-defined relationship in the relative amounts of the fluorocarbon, oil and surfactant components. This specific relationship or interdependence is best depicted and described by reference to Figure 1.
  • the emulsions of this invention are defined as a volume on a three-dimensional plot of w/w% oil/fluorocarbon, w/w% surfactant/fluorocarbon, and % volume fluorocarbon. Emulsions falling within this volume, or on the surfaces defining it, are within the scope of this invention. Emulsions falling outside of this described volume and these surfaces are, correspondingly, not part of this invention.
  • Figure 1 is based on emulsions prepared with perfluorodecalin, egg yolk lecithin and safflower oil, we believe that other combinations of fluorocarbons, oils and surfactants, as described above, will display a similar interdependence of components. However, it should be understood that slightly different volumes and surfaces may define the actual interrelationship of the components of those other emulsions. It is plainly within the skill of the art based on the teachings of this application to determine those exact volumes and surfaces without undue experimentation and without departing from the scope and teachings of this invention.
  • the fluorocarbon is perfluorodecalin
  • the surfactant is egg yolk lecithin
  • the oil is safflower oil.
  • the perfluorodecalin is present in about 40% by volume, the lecithin present in about 2.3 w/w% lecithin/PFD and the safflower oil present in about 2.6 w/w% oil/PFD.
  • the emulsions of this invention may be prepared using any order of mixing the three components and water. However, we prefer to mix the oil first with a water dispersion of the surfactant. We then prepare the final emulsion by adding the fluorocarbon.
  • the mixing and emulsification of the components of the emulsions of this invention may be done with any of the mechanical homogenizers in commercial use, and do not require the use of excess equipment such as ultrasonic homogenizers, although such equipment may be used in laboratory scale production.
  • Powdered, refined, egg yolk lecithin was obtained from Kabi Vitrum and dispersed in sterile H2O under an inert atmosphere (N2) using a WaringTM Blender at high speed for 2 minutes.
  • the blended material was transferred to a reservoir, again under an inert atmosphere, which fed a MicrofluidizerTM Model 110 homogenization apparatus.
  • the material was cycled through the homogenizer for a total of 5 min at a flow rate of 350 ml/min, using 4.22 kg/cm2 air pressure to drive the pump piston, which corresponds to 562-633 kg/cm2 at the homogenizer valve.
  • the temperature was maintained below 25°C throughout. In this manner, approximately 750 g lots were prepared, at concentrations ranging from 10-27%.
  • the lecithin so dispersed was collected under an inert atmosphere and stored at 4°C. All lecithin dispersions so prepared were used within one week of their preparation.
  • the emulsifier reservoir was first loaded with the appropriate charge of sterile water, glycerol, and lecithin dispersion described above. The emulsifier was then started, and the oil was added via a syringe pump at a flow rate of from 10-30 ml/min directly into the inlet port of the homogenizer. The perfluorocarbon was then added via syringe pump at the same flow rate into the same port. The temperature was maintained at 45-48°C throughout, and the pH was maintained at 7.5-8.5 by controlled addition of 0.29 M NaHCC3 or other base. For a 250-ml batch, the material was cycled through the homogenizer at a flow rate of 300-350 ml/min for 10 minutes. Proportionately longer mean residence times were used for larger batch sizes (e.g., for a 500-ml batch, a residence time of 20 minutes was employed).
  • PSD Serum Stability
  • Samples were diluted 1:1 with a 4:1 mixture of lactated Ringer's solution and 25% human serum albumin (HSA), buffered to pH 7.2 with a phosphate buffer. Samples were incubated at 37°C for 120 hrs. before particle size distribution analysis.
  • HSA human serum albumin
  • Doubly cannulated rats (jugular vein/carotid artery) were isovolumically exchanged according to Goodin et al., "A Method For Evaluation Of Blood Substitutes In The Conscious Animal", Am. Jour. Physiol. , 245, H519-523 (1983) until the hematocrit was approximately 3%.
  • the initial FiO2 of 0.8 was reduced daily at 0.1 increments over a 4-day span, after which the animals were returned to room air. Survival was scored at 14 days.
  • test emulsion 50 ml/kg of a 4:1 mixture of stem emulsion (40% by volume PFC) and annex (equivalent to 16 ml/kg of fluorocarbon component) is infused at a rate of 1 ml/kg via the tail vein of 10 140-200g Sprague-Dawley rats lightly anesthesized with ether. After infusion, the animals are returned to their cage and supplied with food and water ad libitum . After 14 days the survival rate is scored. Test emulsions of other PFC volume percents would be prepared similarly to adduce 16 ml/kg of fluorocarbon component
  • test emulsions are stored in serum stoppered 100 ml bottles under a nitrogen atmosphere at 4°C or 25°C for at least three months. After storage, the samples are tested for particle size distribution (laser light scattering), pH, and visual quality (color, creaming, etc.).

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EP89905857A 1988-04-29 1989-04-10 Improved emulsions of highly fluorinated organic compounds Expired - Lifetime EP0449825B1 (en)

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US187854 1988-04-29
US07/187,854 US5171755A (en) 1988-04-29 1988-04-29 Emulsions of highly fluorinated organic compounds
PCT/US1989/001388 WO1989010118A1 (en) 1988-04-29 1989-04-10 Improved emulsions of highly fluorinated organic compounds

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EP0449825A1 EP0449825A1 (en) 1991-10-09
EP0449825B1 true EP0449825B1 (en) 1994-10-19

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US (3) US5171755A (zh)
EP (1) EP0449825B1 (zh)
JP (1) JPH0798745B2 (zh)
KR (1) KR940002658B1 (zh)
CN (1) CN1042794C (zh)
AT (1) ATE112958T1 (zh)
AU (1) AU629832B2 (zh)
CA (1) CA1336494C (zh)
DE (1) DE68918952T2 (zh)
DK (1) DK172973B1 (zh)
IE (1) IE65288B1 (zh)
IL (1) IL90009A0 (zh)
NZ (1) NZ228686A (zh)
OA (1) OA09322A (zh)
WO (1) WO1989010118A1 (zh)
ZA (1) ZA892924B (zh)

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US5407962A (en) 1995-04-18
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CA1336494C (en) 1995-08-01
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CN1042794C (zh) 1999-04-07
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ZA892924B (en) 1989-12-27
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AU3566489A (en) 1989-11-24
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US5350571A (en) 1994-09-27
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US5171755A (en) 1992-12-15
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ATE112958T1 (de) 1994-11-15
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EP0449825A1 (en) 1991-10-09
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